Papillary Muscle Perfusion Pattern

Voci, Paolo; Bilotta, Federico; Caretta, Quintilio; Mercanti, Corrado; Marino, Benedetto

doi:10.1161/01.cir.91.6.1714

Cited by 105 publications

(26 citation statements)

References 26 publications

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“…The increased vulnerability of the posteromedial PM is likely related to its blood supply, which is usually dependent on 1 artery (either the right coronary artery [RCA] or the left circumflex coronary artery [LCX]), whereas the anterolateral PM is supplied by 2 arteries (the left anterior descending coronary artery [LAD] and the LCX). 18 This was further supported by Chinitz et al 14 who demonstrated that in patients with posteromedial PM infarction the LCX was the infarct-related artery in 33% and the RCA in 67%, whereas the LAD was never involved. Conversely, in patients with anterolateral PM infarction, the LAD was the infarct-related artery in 72% of patients, the LCX in 22%, and the RCA in 6%.…”

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confidence: 74%

Papillary Muscle Infarction, Mitral Regurgitation, and Long-Term Prognosis

Bax

Delgado

2013

Circ: Cardiovascular Imaging

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than the anterolateral PM (69% versus 31%). The increased vulnerability of the posteromedial PM is likely related to its blood supply, which is usually dependent on 1 artery (either the right coronary artery [RCA] or the left circumflex coronary artery [LCX]), whereas the anterolateral PM is supplied by 2 arteries (the left anterior descending coronary artery [LAD] and the LCX). 18 This was further supported by Chinitz et al 14 who demonstrated that in patients with posteromedial PM infarction the LCX was the infarct-related artery in 33% and the RCA in 67%, whereas the LAD was never involved. Conversely, in patients with anterolateral PM infarction, the LAD was the infarct-related artery in 72% of patients, the LCX in 22%, and the RCA in 6%. 14 Third, there seems to be some variability in the clinical correlates associated with PM infarction. Chinitz et al 14 demonstrated that patients with PM infarction had larger infarct size on MRI (16.0±10.9% of the LV versus 12.3±8.9% in patients without PM involvement; P<0.05). In these patients, myocardial scar most often involved the lateral and inferior walls. In addition, the infarct-related artery was more often the RCA or LCX. Similar findings were reported in the current study by Eitel et al 15 ; patients with PM infarction had delayed reperfusion, more often multivessel disease, and a lower frequency of LAD as infarct-related artery and anterior infarction. On MRI, these patients had larger infarct size, scar more often observed in lateral and inferior walls, less myocardial salvage, increased microvascular obstruction, more intramyocardial hemorrhage, and larger LV volumes with impaired LV function. 15 Finally, the various studies that used contrast-enhanced MRI to detect PM infarction have also (to some extent) evaluated the relation with MR. Okayama et al 12 evaluated 60 patients with contrast-enhanced MRI at 25±47 months after infarction; 53% of patients had 1 or both PMs involved. From the same MRI examination, the mitral valve (presence of regurgitation, systolic retraction of the leaflets, annular size) and the left ventricle (function and sphericity) were evaluated. Patients with involvement of both PMs demonstrated larger LV volumes, lower LV ejection fraction, and worse LV sphericity index. These patients had more severe MR associated with mitral annular dilatation, reduced leaflet coaptation, and systolic retraction of the leaflets (expressed as a larger mitral valve tenting area).12 Chinitz et al 14 performed the MRI <27±8 days after infarction and used echocardiography to assess the severity of MR. Among the total study population, moderate to severe MR was present in 14%; these patients had worse LV function, LV dilatation, mitral annular dilatation, increased tenting height, and reduced leaflet coaptation.14 On contrastenhanced MRI, the patients with MR had more frequent lateral wall infarction (which remained an independent predictor on the multivariable analysis). However, PM infarction was not associated with MR in multivariable analysis. Eitel...

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confidence: 74%

Papillary Muscle Infarction, Mitral Regurgitation, and Long-Term Prognosis

Bax

Delgado

2013

Circ: Cardiovascular Imaging

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“…Contiguous short-axis slices and representative long-axis slices of the LV were obtained 10 minutes after intravenous injection of 0.1 mmol/kg Gd-DTPA (Magnevist, Schering AG, Berlin, Germany). Scan parameters were as follows: repetition time, 4.1 milliseconds; echo time, 1.25 milliseconds; flip angle, 15°; field of view, 350ϫ350 mm; partial echo; matrix, 224ϫ256; and spatial resolution, 1.56ϫ2.24ϫ10 mm 3 reconstructed to 0.68ϫ0.68ϫ5 mm 3 . All images were acquired during breath-hold at end expiration.…”

Section: Mri Protocolmentioning

confidence: 99%

“…On the other hand, the anterior papillary muscle has a dual blood supply from the left anterior descending artery (LAD) and the LCx. 3 …”

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confidence: 99%

Prevalence and Clinical Significance of Papillary Muscle Infarction Detected by Late Gadolinium-Enhanced Magnetic Resonance Imaging in Patients With ST-Segment Elevation Myocardial Infarction

et al. 2010

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Background-The frequency of papillary muscle infarction (PapMI) without rupture has not been fully investigated in vivo. Furthermore, the relationship between papillary muscle dysfunction and mitral regurgitation (MR) has been controversial in patients with ST-segment elevation myocardial infarction. Therefore, the aim of this study was to assess the frequency and clinical characteristics of PapMI without rupture using late gadolinium-enhanced magnetic resonance imaging (MRI) in patients with ST-segment elevation myocardial infarction. Methods and Results-One hundred eighteen ST-segment elevation myocardial infarction patients with primary percutaneous coronary intervention underwent cardiac MRI twice 9Ϯ4 days and 8Ϯ1 months (nϭ104) after myocardial infarction. MR was categorized by echocardiography. Of these patients, 40% were found to have late gadolinium enhancement of papillary muscle, in which the posterior papillary muscle was involved more frequently than the anterior papillary muscle (77% versus 26%; PϽ0.001). PapMI was encountered more frequently in patients with left circumflex and right coronary artery lesions compared with left anterior descending artery lesion (78%, 48%, and 13%; PϽ0.001).By multiple logistic regression analysis, only coaptation height was identified as an independent predictor of the presence of MR. The second cardiac magnetic resonance imaging showed that the infarct size had a positive correlation with left ventricular end-diastolic volume (rϭ0.41, PϽ0.001) and that PapMI was not associated with left ventricular remodeling (Pϭ0.31). Deterioration of MR was not observed in patients with PapMI. Conclusions-PapMI is more frequent than previously thought yet appears to have significant clinical latency. The size of the myocardial infarction, but not the presence of PapMI, seems to affect left ventricular remodeling, and PapMI is not obligatorily associated with MR. (Circulation. 2010;122:2281-2287.)

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“…This branch of the left circumflex artery feeds the papillary muscles and can be involved in cases of PMR 2 . PMR complicates up to 5% of cases of fatal, acute MI 3 .…”

Section: Discussionmentioning

confidence: 99%

Three patients with signs of acute flail mitral leaflet seen on emergency department echo: a critical constellation within the focused cardiac exam

Bomann

Stephenson

Wallace

et al. 2014

Australas J Ultrason Med

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Acute flail mitral leaflet is a time‐sensitive, reversible cause of cardiogenic shock. Transthoracic echocardiography (echo) is increasingly becoming a vital tool for non‐cardiologist physicians who treat patients with undifferentiated chest pain and dyspnoea. The sonographic abnormalities seen in acute flail mitral leaflet are within the boundaries of a focused echo. Individually, these findings are non‐specific. As a constellation, however, they are highly suggestive of this disease process. We present a case series of three patients with acute flail mitral leaflet seen on emergency department echo along with a discussion of the findings and the disease itself.

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Papillary Muscle Perfusion Pattern

Abstract: Myocardial infarction may cause papillary muscle dysfunction when the blood supply is provided by one rather than two vessels, as is more frequently the case with the posterior rather than the anterior papillary muscle.

Cited by 105 publications

References 26 publications

Papillary Muscle Infarction, Mitral Regurgitation, and Long-Term Prognosis

Papillary Muscle Infarction, Mitral Regurgitation, and Long-Term Prognosis

Prevalence and Clinical Significance of Papillary Muscle Infarction Detected by Late Gadolinium-Enhanced Magnetic Resonance Imaging in Patients With ST-Segment Elevation Myocardial Infarction

Three patients with signs of acute flail mitral leaflet seen on emergency department echo: a critical constellation within the focused cardiac exam

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